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College of the Overwhelmed


Legal Issues. Handbook Language for Notification/LOA. Medical Privacy Laws very strict ... by events that encourage sharing; art, music, and other traditions. ... – PowerPoint PPT presentation

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Title: College of the Overwhelmed

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Staying Healthy at TuftsStudent Mental Health
and Success
  • Richard Kadison M.D.
  • Chief, Mental Health Service
  • Harvard University Health Service

  • Reduce Stigma, Manage Stress
  • Convince Universities that health and counseling
    resources are wise investments
  • Coordination of care between health, counseling,
    residence, faculty, and administration
  • Integrating Cultural Sensitivity and competence
    into our work

Current issues
  • Integration of Academic Work with student health
    and development
  • EVERYONE on campus is responsible for student
    well being.
  • Coordination of care
  • More serious mental health problems on campus.
    Helping high risk students

Stress on Staying Healthy
  • Eat, Sleep, Exercise
  • Stay connected with friends/ community
  • Provide tools to manage stress
  • Educate community to reduce stigma thru education
    about common problems and how to recognize
    warning signs.
  • Create multiple portals of entry to care

Staying Healthy
  • Stressing Personal and professional Development
  • Service Opportunities Engaged Learning
  • Health Education and Information (MRSA)
  • Alcohol and Nutrition info (BAL BMI)
  • Complementary Services Acupuncture, Massage,
    Yoga, Mindfulness

Student Participation/ Engagement
  • Key for Successful Outreach
  • Peer Counseling/ Education Programs
  • Student Health Advisory Group
  • Wellness representatives in the dorms
  • Mental Health Advocacy Group/Active Minds
  • Involve in screenings and education

Getting Care
  • Multiple ways to access care
  • Chaplains, Advising system, residence system
  • Information about resources and warning signs for
    parents and families
  • Stress relieving events and workshops at high
    stress times (massage, food, activities/

Access to Care
  • Triage system Who needs to be seen today
  • Inside vs. Outside Care
  • Community Resources
  • Hospital and Medical Leave, Reentry
  • When should students go home? How to decide
  • Teach Wellness Eat, Sleep, Exercise

Lessons from Virginia Tech
  • Students in distress often dont seek or avoid
  • When students are mandated for assessment,
    there must be follow up and clear consequences
  • When students return from hospital care, a
    careful internal review process is critical

Lessons from Virginia Tech
  • Violence is very rare and difficult to predict
    (prior violence best predictor)
  • There must be a community effort to reduce
    stigma, recognize risk factors, and find portals
    to care. Educate everyone
  • Counseling and Health Services can and should
    provide consultation to the community (students,
    faculty and staff)

Lessons from Virginia Tech
  • Schools must find ways to respect medical
    privacy, but coordinate concerns
  • If students cant expect privacy, they wont seek
  • There must be communication, sometimes one way,
    between faculty, administration, family,
    counseling when concerns arise about a student

Youth Risk Survey 2001 13,600 HS students
  • 28.3 sad or hopeless almost every daygt 2 wks
    stopped some activity due to symptoms
  • 19 percent of students reported that they
    seriously considered attempting suicide
  • 14.8 percent had made a specific plan to attempt
  • 8.8 percent had attempted suicide in the previous
    year Grunbaum et al 2002.

College Data ACHA and Kansas State
  • Depression Doubled, Suicidal Ideation Tripled,
    Sexual Assaults quadrupled over 13 years
  • 45 students self report depression
  • 10 report serious suicidal ideation and 44
    binge drink
  • These are the best years of your life

ACHA College Data
  • 9 seriously consider suicide 1 attempt
  • Depressed 52-42 2000/2006
  • No Sexual partners 40 vs. 5 perceived
  • Medication for depression 36-42

Graduate Students
  • Often at higher risk, higher suicide rates
  • Economically in worse shape, many have no
  • Berkeley Graduate Student Mental Health Survey
    Dec. 2004 showed similar findings to undergrad

Berkeley Grad School Survey
  • 45.3 respondents experienced emotional or stress
    related problem SIGNIFICANTLY affected well
    being/ academic performance
  • 9.9 seriously thought about suicide
  • 52 considered using counseling less than 33 did
  • 25 unaware they were available

Learning from Each Other
  • Peter Leviness undergraduate student survey
    engaged students to highlight and address campus
    stress U. Richmond
  • Jan Collins-Eaglin 1st. Generation,
    multicultural students need language for therapy,
    Wayne State
  • Ron Chapman Pre and post counseling GPA changes-
    increased 1.0 BYU

Stories to Spread the Word
  • Educate the community to reduce Stigma College
    Wide Events
  • Being Depressed at HBS
  • Walk the walk of the student on your campus
    illness in family, high fever, serious alcohol
    problem. How do you get help? Web?

Healthcare 2007
  • BIG changes in the last decade
  • Severity of Problems of students making it to
  • Managed Care Shorter Hospital Stays and more
    alternative treatments
  • Reduced outpatient community resources
  • Higher insurance costs for students

Impediments to Academic Success
  • Stress 32.4
  • Cold/Flu 25.6
  • Sleep Problems 24.6
  • Depression 15.3
  • Internet Use/ Games 13.4 (3-6 of students
    addicted to internet pornography 20 are women)

Sleep Problems
  • 35 of adult population experience insomnia
  • 11 of college students get a good nights
  • Loss of cognitive functioning, driving
  • Increased risk of depression
  • lt 7 hours yields sleep deprivation

Common Problems
  • Developmental Adjustment, Relationships
  • Depression
  • Anxiety
  • Eating Disorders
  • Bipolar Disorder
  • Acute Psychosis
  • Substance Abuse

High Risk Issues
  • Eating Disorders
  • Dual diagnosis Substance Abuse/ depression
  • Bipolar Illness and Psychosis
  • Reentry from Hospitalization

Eating Disorders
  • Anorexia, Bulimia, EDNOS
  • 1 Anorexia, 3-5 Bulimia, 15-20 DE
  • 5-15 mortality from anorexia
  • 1/3 of people dont improve from serious anorexia

Substance Abuse
  • Binge Drinking- 5 or more drinks one sitting in
    past 2 weeks
  • 44 meet criteria in national surveys
  • 41 did something they regretted
  • 31 forgot what they did
  • 9.7 unprotected sex
  • 17 physically injured

Substance Abuse
  • Dont stigmatize medical services. Separate from
  • BASICS Motivational interviewing and education
    shows best results with reducing high risk
  • Consistent enforcement policies and consequences
    for students with identified AODS team on campus

Stimulant Abuse
  • 900 increase in production of methylphenidate
    (Ritalin) 1990-2000
  • 3-7 school age kids ADHD
  • 50 carries over into college
  • 16 use recreationally by mouth, snorting or by
    injection 30 share

  • Long Term Risk factors
  • Prior attempts
  • Feelings of hopelessness
  • Suicidal plan, isolation, prior attempts
  • 10 attempters die over 10 years
  • 45 of 76 suicides occurred during first week post

Legal Issues
  • Shin case settled but issues unresolved
  • Virginia Tech Refusal of care by student
  • George Washington, Hunter College student
  • Allegheny College Suicide

Legal Issues
  • Handbook Language for Notification/LOA
  • Medical Privacy Laws very strict
  • FERPA (Family Education Rights and Privacy Act)
  • Prohibits disclosure of education records
  • Permits disclosure gained through observation
  • Permits disclosure of safety emergency

Leave of Absence and Return
  • Students rarely want to take time off, but may
    need to
  • When students return, important to review their
    readiness to be back at school internally
  • Contracts and Riders

  • 562 students asking for counseling followed over
    2 year period
  • 0 sessions 65 1-12 79 gt13 83
  • Several studies followed people over 5 years all
    showed dramatically higher retention rates,
    averaging more than 10 for students who used
    counseling services
  • Steve Wilson, Terry Mason, Evaluating the impact
    of receiving university based counseling services
    on student retention
  • Journal of Counseling Psychology 1997 vol 44. no
    3 p. 316-320

  • Social Isolation single most important
    determinent of dropout rates Pascarella and
    Terrazini, 1979
  • Emotional- Social Adjustment items predicted
    attrition better than academic items Gerdes and
    Mallinckrodt 1994
  • 5 year study of Berkeley students and those
    making use of counseling had higher graduation
    rates Frank and Kirk 1975

  • Polarized attitudes of students and staff
  • Antidepressants benefits and risks (bipolar) and
    side effects
  • Sleep Medications
  • Anxiety Medications
  • Stimulants Newer preparations
  • Role with disabilities and judicial issues

  • Antidepressant and Stimulant Safety Controversy
  • Reduction of 20 in prescribing since black box
  • Most prescribed medications on college campuses
    12 of pharmacy budget for antidepressants
  • Side Effects Kiss of death

Multicultural Students
  • Present emotional problems physically
  • Metabolize medications differently
  • May be more comfortable with Pastoral Resources
    follow path of least resistance
  • Vulnerability in language/cultural adjustment and
    symptom presentation
  • Staff sensitivity to cultural beliefs

Diversity Considerations
  • Create a culturally competent community
  • Learn and respect different values and cultures
  • Celebrate the diversity of your community by
    events that encourage sharing art, music, and
    other traditions.
  • Diversity may be via culture, race, ethnicity,
    sexual orientation, economics

Coordination of Care
  • Handbook expectations who gets notified about
    hospitalization/ return
  • Identifying high-risk students
  • How is residence involved with worrisome
  • Eating Disordered or Substance Abusing students
    in residence, what happens?
  • Contracts When to invoke them

  • 70-80 of students get their health information
    from their parents
  • They often feel they are supposed to let go of
    students and need help staying engaged without
    being intrusive
  • Help helicopter parents teach their students to
    fish and become emerging adults

What Must We do?
  • Engage our students in the community Life is
    richer and more satisfying for students who are
    engaged in learning
  • Stress Health and Wellness on campus and create
    opportunities for connections

Wellness Activities
  • Engage Students in community- study breaks,
    hikes, encourage student groups
  • Teach yoga, sleep hygiene, mindfulness,
    relaxation response
  • Have annual wellness or caring events like this
    one or maximize academic potential, minimize
  • Student Wellness Reps.

Coordinating Board
  • All stakeholders Students, Financial and Student
    Service Deans, Residence, Public Safety,
    Ministry, Health, Counseling, Disability
  • Community wide programs for education from top
    down and bottom up set priorities!

Coordinating Board
  • Advisory to Counseling/MH
  • Strategic, Realistic Planning
  • Community vs. Individual needs Insurance
  • Consider having regional meetings with
    shareholders in other area schools to share good
    ideas and increase leverage with local medical/
    community resources

Web Information
  • Online screenings
  • Information/education about alcohol
  • Student made DVD to incoming students
  • Information about resources
  • Many good web resources (JED (Ulifeline),,
  • Launching

  • Emotional and Physical Well-Being are crucial for
    Academic Success
  • We all have to work together
  • Focus on Staying Healthy and Learning Healthy
    Lifestyles Eat, Sleep and Exercise